Dynamic left ventricular outflow tract obstruction induced by pericardial tamponade during acute anterior myocardial infarction

Deligönül, Ubeydullah; Uppstrom, Erica; Penick, Danny; Seacord, Lynne; Kern, Morton J.

doi:10.1016/0002-8703(91)90973-l

Cited by 19 publications

(5 citation statements)

References 7 publications

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“…1 We observed a decreased 3-dimensional LVOT area and a significant correlation between decreased LVOT area and LVOT gradients in patients with hypertrophic cardiomyopathy. 2 LVOT obstruction has been shown to occur in other clinical conditions including concentric LVOT hypertensive hypertrophy, 3 excessive sympathetic stimulation, 4 pericardial tamponade, 5 and after aortic valve replacement for aortic valve stenosis. 6 Recently, the occurrence of a dynamic LVOT obstruction has been described in the setting of acute myocardial infarction (MI).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy

et al. 2004

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Basal septal hypertrophy (BSH), a cause of left ventricular outflow tract (LVOT) obstruction, is thought to occur by increased ventricular dynamics. The aim of the study was to evaluate the effect of pharmacologic stress on LVOT gradients in a group of hypertensive patients with BSH. Dobutamine stress was used in 24 hypertensive patients (mean age 56 +/-8 years; 11 women) with BSH and 20 normal controls (mean age 54 +/-9 years; 7 women). Ejection fraction and myocardial mass, basal septal dimension, and LVOT diameter were measured with 2-dimensional echocardiography. LVOT velocities and transmitral velocities before and at peak dobutamine infusion were determined by continuous wave Doppler and pulsed Doppler, respectively. There were no differences in mean ejection fraction and myocardial mass between BSH patients (58 +/-3%, 204 +/-24 g) and normals (56 +/-4%, 201 +/-32 g). The basal septum was thicker in patients (1.55 +/-0.2 cm) than in normals (1.03 +/-0.1 cm, p<0.001). Maximum LVOT velocities were similar in BSH (1.2 +/-0.4 m/sec) and normals (1.1 +/-0.2 m/sec) at rest. At peak stress, maximum LVOT velocities were higher in BSH (3.3 +/-0.6 m/sec) than normals (1.7 +/-0.4 m/sec, p<0.001). LV rate-pressure product at peak stress was higher in BSH (23,326 +/-4,388) than normals (17,592 +/-2,409, p<0.001). LV isovolumetric relaxation time was prolonged, and the E/A ratio was decreased in the patients at rest (130 +/-14 msec and 0.72 +/-0.18, respectively, p<0.001). At peak stress, diastolic function did not significantly change in two groups. The correlations between LVOT velocity change by stress and mean LVOT diameter (r=-0.668, p<0.001) and mean BS thickness (r=0.610; p<0.001) were significant in the whole group. High velocities appeared on LVOT at peak pharmacologic stress in the hypertensive patients with BSH compared with control group. This suggests dynamic ventricular ejection by stress may contribute to hypertrophy of the basal segment, which is the closest part of septum to increased afterload.

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Section: Introductionmentioning

confidence: 99%

The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy

et al. 2004

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“…Examples include hypertrophic cardiomyopathy [21], after mitral valve repair, aortic valve replacement for aortic stenosis [22], circulatory hypovolaemia, external cardiac compression due to pericardial effusion [23], and LV cavity compression due to acute right heart dilatation with acute pulmonary embolus. None of our patients had a history of hypertrophic cardiomyopathy although its presence cannot be completely excluded.…”

Section: Discussionmentioning

confidence: 99%

Dynamic left ventricular obstruction: A potential cause of angina in end stage renal disease

Sharma

Pellerin

Gaze

et al. 2006

International Journal of Cardiology

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“…There seem to be different mechanisms and sites of gradient formation in the various types of LVH [21, 22]. In patients with aortic valve disease [23, 24], after reconstruction or replacement of the mitral valve [25], in patients with cardiac amyloidosis [26]or pericardial tamponade [27], intracavity pressure differences have been documented by invasive or Doppler methods. In aortic valve disease, outflow acceleration has been associated with excess morbidity and mortality [23].…”

Section: Discussionmentioning

confidence: 99%

Outflow Acceleration Assessed by Continuous-Wave Doppler Echocardiography in Left Ventricular Hypertrophy: An Analysis of 103 Consecutive Cases

Faber

Heemann²,

Sürig³

et al. 1998

Cardiology

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The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 103 nonselected, consecutively enrolled patients with LV hypertrophy (LVH), either due to pressure overload (97 patients) or hypertrophic cardiomyopathy (HCM, 6 patients). In 34 patients with LVH, outflow acceleration (gradients ranging from 18 to 122 mm Hg) was induced or accentuated by the Valsalva maneuver after 1.6 mg nitroglycerine sublingually independent of LVH etiology. Factors associated with LV outflow acceleration were female sex, small body surface area and LV cavity size, increased relative wall thickness, LV contractility, and resting LV outflow velocity, mitral anulus calcifications and systolic anterior movement of the mitral valve. It is concluded that dynamic, intracavity LV gradients are a nonspecific flow abnormality that merit consideration because they can be frequently found in LVH patients.

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Dynamic left ventricular outflow tract obstruction induced by pericardial tamponade during acute anterior myocardial infarction

Cited by 19 publications

References 7 publications

The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy

The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy

Dynamic left ventricular obstruction: A potential cause of angina in end stage renal disease

Outflow Acceleration Assessed by Continuous-Wave Doppler Echocardiography in Left Ventricular Hypertrophy: An Analysis of 103 Consecutive Cases

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